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Introduction: Heparin, a commonly used anticoagulant in cardiac surgery, binds to antithrombin III (ATIII) to prevent clot formation. However, heparin resistance (HR) can complicate surgical procedures, leading to increased thromboembolic risks and bleeding complications. Proper diagnosis and management of HR are essential for optimizing surgical outcomes. Methodology: Diagnosis of HR involves assessing activated clotting time (ACT) and HR assays. Management strategies were identified through a comprehensive review of the literature, including studies exploring heparin dosage adjustments, antithrombin supplementation, and alternative anticoagulants in cardiac surgery patients with HR. A thorough search of relevant studies on HR was conducted using multiple scholarly databases and relevant keywords, resulting in 59 studies that met the inclusion criteria. Discussion: HR occurs when patients do not respond adequately to heparin therapy, requiring higher doses or alternative anticoagulants. Mechanisms of HR include AT III deficiency, PF4 interference, and accelerated heparin clearance. Diagnosis involves assessing ACT and HR assays. HR in cardiac surgery can lead to thromboembolic events, increased bleeding, prolonged hospital stays, and elevated healthcare costs. Management strategies include adjusting heparin dosage, supplementing antithrombin levels, and considering alternative anticoagulants. Multidisciplinary management of HR involves collaboration among various specialities. Strategies include additional heparin doses, fresh frozen plasma (FFP) administration, and antithrombin concentrate supplementation. Emerging alternatives to heparin, such as direct thrombin inhibitors and nafamostat mesilate, are also being explored. Conclusion: Optimizing the management of HR is crucial for improving surgical outcomes and reducing complications in cardiac surgery patients. Multidisciplinary approaches and emerging anticoagulation strategies hold promise for addressing this challenge effectively.

Background: The del Nido cardioplegia solution is a widely used method for myocardial protection in various settings. However, there is limited evidence of its effectiveness in adult cardiac surgery, and the baseline solution, Plasma Lyte A, is not readily available, leading to the use of alternative baseline solutions. This study aims to investigate the effectiveness of routine del Nido cardioplegia in adult cardiac surgery and the impact of different baseline solutions on myocardial protection and other perioperative outcomes. Methods: This study was a prospective, double-blind randomized parallel group clinical trial conducted at a single tertiary care hospital in Iran. A total of 187 adult patients were evaluated for eligibility, of which 120 met the inclusion criteria for elective isolated CABG surgery. The patients were randomly assigned to three groups, with each group consisting of 40 patients. The control group received a normal saline-based routine del Nido cardioplegia, Intervention Group A received Ringer lactate-based del Nido cardioplegia, and Intervention Group B received plain Ringer-based del Nido cardioplegia. The levels of Creatine Kinase-MB (CK-MB), Troponin T, Troponin I, and lactate were primarily assessed at four different times: after anesthesia induction (Baseline), 2 h, 12 h, and 24 h. Results: Preoperative demographic and clinical characteristics were the same among groups with insignificant differences (p > 0.05). There was no significant difference among groups based on CK-MB, Troponin T, Troponin I, and lactate levels (p = 0.078, 0.143, 0.311, and 0.129 respectively). However, there was a significant difference in the time effect of Troponin T and Lactate (p = 0.034, p =

Sheath blight disease in rice, induced by the necrotrophic basidiomycetes Rhizoctonia solani, has emerged as a significant menace to global rice cultivation, especially with the widespread adoption of high-yielding varieties. The pathogen’s capacity to endure unfavorable conditions and its wide host range contribute to the increased challenge for management. The occurrence of sheath blight in rice is intensified when high-yielding semi-dwarf cultivars are employed, coupled with dense planting and the application of substantial amounts of nitrogenous fertilizers. Managing this pathogen is a formidable challenge due to its broad host range, substantial genetic variability, and the absence of satisfactory levels of natural resistance in the existing rice germplasm. Due to the absence of complete resistance sources, the predominant approach for managing sheath blight has been through chemical control methods. It is imperative to explore solutions to combat this pathogen, in order to reduce rice yield losses and safeguard global food security. Developing genetic resistance provides an alternative to the use of potentially harmful chemical fungicides. This review crucially delivers efforts to enhance the understanding of the host–pathogen relationship, which involves identification of gene loci/markers associated with resistance responses, modification of host genome through transgenic approaches, examining the wide host range, epidemiology and its managemental approaches. Recent advancements and current research on the R. solani–rice pathosystem, along with a gap analysis, are presented.

Background. Chronic kidney disease (CKD) is an epidemic health problem responsible for an increase in morbidity and mortality secondary to various complications, especially cardiovascular events. Previous studies have suggested that biochemical markers of metabolic bone disease (MBD) are associated with an increase in cardiovascular events by causing left ventricular hypertrophy (LVH). Therefore, the present study aimed to evaluate the association between LVH and CKD-MBD markers as a major predictor for cardiovascular disease (CVD) in CKD patients.

This article depicts the heat and mass transport of the double-diffusive convective flow of Walter-B viscoelastic fluid in highly permeable porous media with an internal heat source. We used weakly nonlinear analysis to quantify the nature of heat and mass transport using the Ginzburg–Landau equation. The Ginzburg–Landau equation has been derived in terms of the amplitude of the stream function. The effect of physical parameters has been examined on Nusselt and Sherwood numbers, which has represented graphically. According to the boundary condition, we have discussed the four scenarios based on the phase angles. Our study has demonstrated that internal heat plays a significant role in heat transfer processes. Furthermore, the elastic parameter leads to a transient augmentation in the heat and mass transfer rate. The main output of the current study is that the highest transport was found when both the modulations were put in out-phase condition (Scenario 1).

Edeltraut Garbe,1 Fabian Hoti,2 Tania Schink,1 Kristian Svendsen,3 Haydar Al-Eid,4 Per Arkhammar,5 Marie Carlholm,6 Harald Fjällbrant,6 Stefan Franzén,7,8 Cecilia Hedlund,9 Bianca Kollhorst,10 Atul Kumar,11 Muriel Lobier,2 Vasili Mushnikov,2 Tore Persson,9 Xu Qiao,2 Aaro Salosensaari,12 Wiebke Schäfer,1 Nicholas M Sicignano,13 Gunnar Johansson,14 Eileen O Dareng15 1Department Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany; 2Biostatistics, Scientific Services, Real World Solutions, IQVIA, Espoo, Finland; 3Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway; 4United States Navy, Naval Medical Center, Portsmouth, Virginia, USA; 5Global Patient Safety Biopharma, AstraZeneca, Gothenburg, Sweden; 6Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden; 7BPM Evidence Statistics, Medical Evidence, BioPharmaceuticals Medical, Gothenburg, Sweden; 8School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 9Biometrics, Late-stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden; 10Department Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany; 11Global Patient Safety Biopharma, AstraZeneca, Bangalore, India; 12Biostatistics, Scientific Services, Real World Solutions, IQVIA, Turku, Finland; 13Health ResearchTx LLC, Trevose, Pennsylvania, USA; 14Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; 15Safety Epidemiology and Risk Management, AstraZeneca, Cambridge, UKCorrespondence: Eileen O Dareng, AstraZeneca, City House, 126-130 Hills Road, Cambridge, CB2 1RY, United Kingdom, Tel +44 7789447801, Email eileen.dareng@astrazeneca.comPurpose: This study evaluated the long-term safety of roflumilast in patients with chronic obstructive pulmonary disease or chronic bronchitis using electronic healthcare databases from Germany, Norway, Sweden, and the United States (US).Patients and Methods: The study population consisted of patients aged ≥ 40 years who had been exposed to roflumilast and a matched cohort unexposed to roflumilast. The matching was based on sex, age, calendar year of cohort entry date (2010– 2011, 2012, or 2013), and a propensity score that included variables such as demographics, markers of chronic obstructive pulmonary disease (COPD) severity and morbidity, and comorbidities. In comparison to the unexposed matched cohort (never use), three exposure definitions were used for the exposed matched cohort: ever use, use status (current, recent, past use), and cumulative duration of use. The main outcome was 5-year all-cause mortality. Cox regression models were used to estimate crude and adjusted hazard ratios (HRs) and 95% confidence intervals (CI).Results: 112,541 unexposed and 23,239 exposed patients across countries were included. Some variables remained unbalanced after matching, indicating higher COPD disease severity among the exposed patients. Adjusted HRs of 5-year all-cause mortality for “ever use” of roflumilast, compared to “never use”, were 1.12 (95% CI, 1.08– 1.17) in Germany, 1.00 (95% CI, 0.92– 1.08) in Norway, 0.98 (95% CI, 0.92– 1.04) in Sweden, and 1.16 (95% CI, 1.12– 1.20) in the US. Compared to never users, there was a decrease in 5-year mortality risk observed among “current users” in Germany (HR: 0.93, 95% CI: 0.88– 0.98), Norway (HR: 0.77, 95% CI: 0.67– 0.87), and Sweden (HR: 0.80, 95% CI: 0.73– 0.88).Conclusion: There was no observed increase in 5-year mortality risk with the use of roflumilast in Sweden or Norway. A small increase in 5-year mortality risk was observed in Germany and the US in the ever versus never comparison, likely due to residual confounding by indication.Keywords: roflumilast, 5-year all-cause mortality, COPD, electronic healthcare database, propensity score

Manufacturing has experienced an immense transformation since the emergence of Industry 4.0. Digitalization has substantially improved production efficiency and product quality, and innovative business models have emerged. The backbone of emerging countries like India comprises small and medium enterprises (SMEs) that provide jobs for millions of families. Small and medium-sized businesses (SMBs) account for around 31% of the nation’s GDP and 43% of 2021–2022 exports, both significant contributors to economic growth when there is a substantial labour pool. Therefore, they are often known as India’s growth engine. Unfortunately, in today’s highly competitive digital market, they fail to keep pace with technological innovations and keep their employees up to date. This article discusses the significance of digitalization for India’s SMEs, addressing the hurdles and the methods to remove them. New consumer markets have been established due to government programs like Make in India, Digital India, and E-Government.

Background: The outbreak of coronavirus disease 2019 (COVID-19) pandemic is currently an international public health crisis. The Indian government had announced the suspension of colleges indefinitely across India. Students of medical colleges are facing distress due to the abrupt disruption of academic routine. Objectives: The study aimed to assess the prevalence and correlates of stress, anxiety, and depression among undergraduate medical students of a medical college of North India during COVID-19 pandemic. Materials and Methods: A cross-sectional study was conducted among medical students of a medical college in North India. Data were collected via a prevalidated, semi-structured questionnaire consisting of sociodemographic and behavioral questions and three standard psychometric scales, i.e., Perceived Stress Scale, Coronavirus Anxiety Scale, and Major Depression Inventory Scale for assessing stress, anxiety, and depression, respectively. Data were analyzed using the Statistical Package for the Social Sciences (version 27.0; SPSS Inc., Chicago, IL, USA). Results: We reported that majority of students (86.5%) have increased social media usage. The level of stress is moderate (72.5%) to high (19%), and depression is also reported in many students from moderate (11%) to severe (17.8%) levels. A small proportion of students showed anxiety though anxiety scores are significantly higher for males than females and for 1st- and 2nd-year subjects than final-year subjects. More than 60% of students are physically active who also showed a low level of stress, depression, and anxiety than sedentary subjects. Conclusion: Our results show that stress, anxiety, and depression were high in medical students during lockdown. Increased food intake and social media usage were risk factors for developing stress, anxiety, and depression. Physical activity has a positive impact on mental health of the students.

The implementation of three-dimensional (3D) printing technology has culminated in a notable rise in productivity and operational effectiveness for manufacturers. Additive manufacturing (AM) is a manufacturing technology that implies an alteration from the conventional approach of material removal. The fundamental idea underlying the AM technique is the gradual buildup of layers (layer-on-layer accumulation). In conventional approaches, every component can have detrimental implications due to the direct interaction between the tool and the workpiece, leading to the loss of heat through friction. The utilisation of 3D printing as a way to surpass conventional processing methods signifies a novel development in several sectors. This method involves the utilisation of unconventional techniques for the fabrication of components. The primary objective of this research is to investigate the chemical vapour jet drilling technique specifically applied to acrylonitrile butadiene styrene (ABS) materials. The intent is to enhance the surface characteristics, or surface finish (SF), and the dimensional accuracy (DA) of ABS workpieces. An evaluation regarding the reliability, repeatability, as well as preciseness of the vapour jet drilling (VJD) process is conducted via the utilisation of experiment and data analysis. The study employed a Taguchi L9 design of experiments to carry out a series of tests aimed at analysing the implications of three independent variables: pressure, flow rate, and standoff distance. The researchers employed a multiresponse optimisation approach to attain an optimal combination of parameters that resulted in a superior SF with DA. Consequently, the overall appeal of the outcome was reached. The process’s capabilities and dependability were assessed by conducting tests on the substrates at their optimal settings. Surface roughness and circularity were measured at numerous locations on the substrates. The study determined that the process capability indices (C p and C pk) had values over 1.33 for each of the response parameters, with C pk values also exceeding 1. The analysis of histograms and capability indices demonstrates that the VJD method, when conducted under optimised conditions, may be categorised as statistically controlled for the processing of ABS materials.

Abstract Centrin1 gene deleted Leishmania donovani parasite (LdCen1 −/− ) was developed and extensively tested experimentally as an intracellular stage-specific attenuated and immunoprotective live parasite vaccine candidate ex vivo using human PBMCs and in vivo in animals. Here we report manufacturing and pre-clinical evaluation of current Good-Laboratory Practice (cGLP) grade LdCen1 −/− parasites, as a prerequisite before proceeding with clinical trials. We screened three batches of LdCen1 −/− parasites manufactured in bioreactors under cGLP conditions, for their consistency in genetic stability, attenuation, and safety. One such batch was preclinically tested using human PBMCs and animals (hamsters and dogs) for its safety and protective immunogenicity. The immunogenicity of the CGLP grade LdCen1 −/− parasites was similar to one grown under laboratory conditions. The cGLP grade LdCen1 −/− parasites were found to be safe and non-toxic in hamsters and dogs even at 3 times the anticipated vaccine dose. When PBMCs from healed visceral leishmaniasis (VL) cases were infected with cGLP LdCen1 −/− , there was a significant increase in the stimulation of cytokines that contribute to protective responses against VL. This effect, measured by multiplex ELISA, was greater than that observed in PBMCs from healthy individuals. These results suggest that cGLP grade LdCen1 −/− manufactured under cGMP complaint conditions can be suitable for future clinical trials.

Objective: The authors report the results of “only-fixation” of the affected spinal segment without any decompression of the bones or soft tissue or manipulation of the cyst wall or contents in eight cases having lumbar parafacetal cyst (LPFC). This surgical strategy was based on the concept that LPFCs are secondary to spinal instability, has a protective or adaptive role, and is reversible following stabilization. Materials and Methods: During the period from January 2018 to January 2023, eight consecutive patients having LPFC were surgically treated. There were 5 males and 3 females, and their ages ranged from 48 to 72 years (average 63 years). Seven patients had a single cyst and one patient had multiple cysts. The patients presented with symptoms classically attributed to lumbar canal stenosis. Apart from the cyst-affected spinal segment, degenerative alterations were observed in adjoining spinal segments in six out of seven patients having a single cyst. All patients underwent “only fixation” of the unstable spinal segments without any kind of bone or soft-tissue resection and without any manipulation or handling of the cyst wall or contents. Results: During the follow-up period that ranged from 12 to 57 months (average 29 months), all patients improved from their symptoms. The recovery was observed in the immediate postoperative period and was lasting. Conclusions: LPFCs are one of the several secondary alterations observed in spinal degeneration. Identification of unstable spinal segments and their fixation constitutes rational treatment of lumbar parafacetal cysts. Direct handling and resection of cysts are unnecessary.

Abstract A class of complex breather and soliton solutions to both KdV and mKdV equations are identified with a Pöschl-Teller type $$\mathscr{P}\mathscr{T}$$ P T -symmetric potential. However, these solutions represent only the unbroken- $$\mathscr{P}\mathscr{T}$$ P T phase owing to their isospectrality to an infinite potential well in the complex plane having real spectra. To obtain the broken- $$\mathscr{P}\mathscr{T}$$ P T phase, an extension of the potential satisfying the $$sl\left( 2,\mathbb {R}\right)$$ s l 2 , R potential algebra is mandatory that additionally supports non-trivial zero-width resonances.

Abstract Lead (Pb) contamination in water poses a significant threat to public health across the globe which requires effective remediation strategies. The main objective of this study is to achieve a removal efficiency of Pb(II) ions from aqueous media using activated Syzygium cumini (java plum) stem biochar. It was prepared by slow pyrolysis at 400 °C after treating the biomass with potassium hydroxide for activation. These biochars were characterized thoroughly (SEM, SEM–EDX, TEM, FTIR, XRD, elemental analyses, and SBET) to conduct a set of batch experiments. The effect of several parameters such as pH, temperature, contact time, adsorbent dosage, initial lead concentrations, and co-existing ions were explored. The decrease in starting lead concentrations from 50 to 10 mg L−1 resulted in improved removal efficiency. The removal effectiveness of activated biochar was 97%, but non-activated biochar was just 19%. Lead adsorption increased considerably as pH increased from 3 to 5. Further, the activated biochar was optimized through various isotherms models, kinetic equations, and thermodynamic analysis. It was observed that the pseudo-second-order kinetic model and Temkin isotherms were the best-fitted models that identify the mechanism of chemisorption and monolayer sorption. According to this study, activated biochar is a promising biosorbent for removing lead from an aqueous solution. Graphical Abstract

Background: Because of its ease and visual attractiveness, clear aligner therapy has grown in popularity as an orthodontic treatment option. On the other hand, the results of therapy may be impacted by attachment wear. Comparing attachment wear in three distinct clear aligner systems—System A, System B, and System C—was the goal of this investigation. Methods: The research comprised 60 individuals receiving clear aligners as part of their orthodontic treatment. Depending on whatever clear aligner system was being utilised, the patients were split into three groups. Attachment wear was evaluated using a standardised scoring method regularly. The various systems’ attachment wear was compared using statistical analysis. Results: Compared to Systems B and C, System A showed less attachment wear. There were notable variations in attachment wear ratings between the systems. System C’s attachments had the most wear, whereas System A’s attachments had the least. Conclusion: Different clear aligner systems showed varying degrees of attachment wear, with System A exhibiting the least amount of wear. To maximise treatment procedures and guarantee treatment efficacy and longevity in clear aligner therapy, it is vital to comprehend attachment wear patterns.

Background: Vaccination of neonates is crucial for preventing infectious diseases and ensuring public health. However, understanding the attitudes of healthcare providers and parents towards neonatal vaccination and the challenges in implementing vaccination schedules is essential for optimizing vaccination strategies. Materials and Methods: A clinical study was conducted involving healthcare providers and parents of neonates. Surveys were administered to assess attitudes towards neonatal vaccination, perceived barriers, and adherence to vaccination schedules. Data analysis was performed using statistical methods to identify trends and associations. Results: Among healthcare providers (n = 200), 85% expressed strong support for neonatal vaccination, citing its importance in disease prevention. However, concerns regarding vaccine safety (62%) and parental hesitancy (48%) were identified as significant barriers. Among parents (n = 500), 78% reported willingness to vaccinate their neonates, with 60% adhering strictly to vaccination schedules. Common reasons for non-adherence included fear of adverse reactions (42%) and misinformation (28%). Challenges in vaccine administration, such as access issues (20%) and vaccine shortages (15%), were also reported. Conclusion: Healthcare providers generally endorse neonatal vaccination, recognizing its benefits in preventing infectious diseases. However, addressing concerns about vaccine safety and parental hesitancy is crucial for improving vaccination rates. Strategies aimed at enhancing education, promoting vaccine confidence, and addressing logistical challenges are essential for the successful implementation of neonatal vaccination schedules.

The study examined the emission of electromagnetic radiation (EMR) from cement/Ba0.06Bi0.47Na0.47TiO3 (BBNT) composites when subjected to drop weight impact loads, aiming to explore their potential as sensors in civil structures. The generation of EMR in this context can be attributed to the increased movement of ions within pores and dipole oscillation along the grain boundaries of BBNT. The increase of BBNT content and impact load cause a noticeable rise in the values of EMR voltage, dominant frequency and the average rate of EMR energy release. Notably, the impact-generated EMR voltage data can be excellently fitted with a 5th-order bivariate polynomial function (adjusted r2 = 0.9353). Furthermore, the EMR voltage exhibits a decreasing pattern when measured at various distances from the sample, until it stabilizes after 12 cm. These findings suggest that the EMR technique holds promise as an effective tool for real-time monitoring of civil structures in situ.

The development of coastal roads and bridges is important to overcome traffic congestion in densely populated coastal cities like Mumbai. In the present study, the importance of assessment of wave conditions required for the extension of jetties to facilitate the transportation of bridge components to build the sea link bridge during non-monsoon season is envisaged so that zero downtime for operability at jetties is ascertained. A coupled hydrodynamic spectral wave model (Telemac-2D and TOMAWAC) used to hindcast waves reveals that the application of spatio-temporally varying 2D directional spectrum (from ERA-5) over the offshore boundary as a forcing function helps in propagation of a realistic wave climate of Mahim Bay, Mumbai. Coupling of the TOMAWAC-ARTEMIS model is essential to obtain reliable wave conditions near the jetties (nearshore) for predominant directions. The study reveals that under existing conditions, downtime at proposed jetties will be for 30 days wherein Hs ≥ 0.3 m. To achieve zero downtime, the existing bund on the seaward side of jetties was extended optimally (70 m) so that smooth operability for the entire non-monsoon is achieved. Thus, application of spatio-temporally varying 2D spectrum in optimising the length of the guide bund has been found promising for speedy transportation of proposed bridge components. The study also reveals that there is an insignificant climatological impact on wave conditions. HIGHLIGHTS coupled hydrodynamic and spectral wave (SW) model is used to hindcast waves.; 2D spatio-temporally varying wave spectrum was used as a forcing function.; Predominant wave conditions of the Mahim Bay were obtained.; Climatological trend of the wave condition was analysed.; Coupled SW and phase resolving model was used.;

Venovenous bypass (VVB) is a technique used in liver transplantation (LT) to maintain hemodynamic stability and abdominal organ perfusion and thereby improve patient outcomes. Despite its perceived benefits, VVB utilization has declined globally due to concerns related to heparinization, major bleeding and the need for expertise. Recent advancements, such as percutaneous cannulation techniques and improved extracorporeal technology have improved the safety of VVB in LT. This paper presents a modified VVB circuit with enhanced safety features. Cannulation plays a pivotal role in VVB establishment, with percutaneous methods increasingly favored. Studies demonstrate VVB’s efficacy in improving patient outcomes with lower incidence of acute kidney injury and reduced operative time and blood loss, with no added morbidity or mortality. However, its routine use faces challenges, with alternative techniques gaining traction. Our experience highlights VVB’s role in various clinical scenarios, including patients with high Model for End-Stage Liver Disease (MELD) scores, challenging surgical anatomy, portal vein thrombosis and pre-existing cardiovascular disease, emphasizing its safety and efficacy. Continued research is needed to optimize VVB techniques and ensure better outcomes for liver transplant recipients.

Many studies have been done in the field of predicting the Volatility of Commodities; however, very little or no analysis has been conducted on any sector, industry, or indices to identify which model is best to understand the asset’s characteristics, as there is a hypothesis that all financial time series can be interpreted by implementing the same model.

Ednan K Bajwa,1 Dawn Cislak,1 Amit Kumar,1 Dan Li,1 Eric J Messina,1 Tom Reynders,2 Jean-François Denef,2 Vasile Corcea,3 Ketan P Buch,4 Eseng Lai,1 S Aubrey Stoch1 1MRL, Merck & Co., Inc., Rahway, NJ, USA; 2Translational Medicine, MSD Belgium, Brussels, Belgium; 3PMSI Republican Clinical Hospital “T. Mosneaga”, ARENSIA EM Unit, Chisinau, Republic of Moldova; 4Department of Internal Medicine, Pulmonary and Critical Care Medicine, Lexington VA Healthcare, Lexington, KY, USACorrespondence: Ednan K Bajwa, Translational Medicine, Merck Research Laboratories Massachusetts LLC, 33 Avenue Louis Pasteur, MAILSTOP BMB-3-420, Boston, MA, 02115-5727, USA, Tel +1 617 992-3470, Email ednan.bajwa@merck.comPurpose: This phase 1 study (NCT04370873) evaluated safety and pharmacokinetics/pharmacodynamics (PK/PD) of MK-5475 in participants with pulmonary hypertension associated with COPD (PH-COPD).Methods: Eligible participants were 40– 80 years old with COPD (FEV1/FVC < 0.7; FEV1 > 30% predicted) and PH (mean pulmonary arterial pressure ≥ 25 mmHg). Participants were randomized 2:1 to MK-5475 or placebo via dry-powder inhaler once daily for 7 days in Part 1 (360 μg) or 28 days in Part 2 (380 μg). Safety was assessed by adverse events (AEs) and arterial blood oxygenation. Part-2 participants had pulmonary vascular resistance (PVR; primary PD endpoint) and pulmonary blood volume (PBV; secondary PD endpoint) measured at baseline and Day 28. A non-informative prior was used to calculate posterior probability (PP) that the between-group difference (MK-5475 – placebo) in mean percent reduction from baseline in PVR was less than − 15%.Results: Nine participants were randomized in Part 1, and 14 participants in Part 2. Median age of participants (86.4% male) was 68.5 years (41– 77 years); 95.5% had moderate-to-severe COPD. Incidences of AEs were comparable between MK-5475 and placebo: overall (5/14 [36%] versus 5/8 [63%]), drug-related (1/14 [7%] versus 2/8 [25%]), and serious (1/14 [7%] versus 1/8 [13%]). MK-5475 caused no meaningful changes in arterial blood oxygenation or PBV. MK-5475 versus placebo led to numerical improvements from baseline in PVR (− 21.2% [95% CI: − 35.4, − 7.0] versus − 5.4% [95% CI: − 83.7, 72.9]), with between-group difference in PVR less than − 15% and calculated PP of 51%.Conclusion: The favorable safety profile and numerical reductions in PVR observed support further clinical development of inhaled MK-5475 for PH-COPD treatment.Keywords: pulmonary hypertension, chronic obstructive pulmonary disease, MK-5475, soluble guanylate cyclase stimulator, dry powder inhaler, pulmonary vascular resistance

Ambadasu Bharatha,1 Nkemcho Ojeh,1 Ahbab Mohammad Fazle Rabbi,2 Michael H Campbell,1 Kandamaran Krishnamurthy,1 Rhaheem NA Layne-Yarde,1 Alok Kumar,1 Dale CR Springer,1 Kenneth L Connell,1 Md Anwarul Azim Majumder1 1Faculty of Medical Sciences, The University of the West Indies, Bridgetown, Barbados; 2Department of Population Sciences, University of Dhaka, Dhaka, BangladeshCorrespondence: Md Anwarul Azim Majumder, Director of Medical Education, Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados, Email azim.majumder@cavehill.uwi.edu Ambadasu Bharatha, Lecturer in Pharmacology, Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados, Email ambadasu.bharatha@cavehill.uwi.eduIntroduction: This research investigated the capabilities of ChatGPT-4 compared to medical students in answering MCQs using the revised Bloom’s Taxonomy as a benchmark.Methods: A cross-sectional study was conducted at The University of the West Indies, Barbados. ChatGPT-4 and medical students were assessed on MCQs from various medical courses using computer-based testing.Results: The study included 304 MCQs. Students demonstrated good knowledge, with 78% correctly answering at least 90% of the questions. However, ChatGPT-4 achieved a higher overall score (73.7%) compared to students (66.7%). Course type significantly affected ChatGPT-4’s performance, but revised Bloom’s Taxonomy levels did not. A detailed association check between program levels and Bloom’s taxonomy levels for correct answers by ChatGPT-4 showed a highly significant correlation (p< 0.001), reflecting a concentration of “remember-level” questions in preclinical and “evaluate-level” questions in clinical courses.Discussion: The study highlights ChatGPT-4’s proficiency in standardized tests but indicates limitations in clinical reasoning and practical skills. This performance discrepancy suggests that the effectiveness of artificial intelligence (AI) varies based on course content.Conclusion: While ChatGPT-4 shows promise as an educational tool, its role should be supplementary, with strategic integration into medical education to leverage its strengths and address limitations. Further research is needed to explore AI’s impact on medical education and student performance across educational levels and courses.Keywords: artificial intelligence, ChatGPT-4’s, medical students, knowledge, interpretation abilities, multiple choice questions

Madhumallika Pathak,1 Vijaya Sahu,2 Aseem Kumar,2 Kirandeep Kaur,3 Bharat Gurnani4 1Department of Ophthalmology, Sai Baba Eye Hospital, Raipur, Chhattisgarh, 492099, India; 2Department of Ophthalmology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, 492099, India; 3Department of Pediatric Ophthalmology and Strabismus, Gomabai Netralaya and Research Centre, Neemuch, Madhya Pradesh, 458441, India; 4Department of Cataract, Cornea and Refractive Surgery, Gomabai Netralaya and Research Centre, Neemuch, Madhya Pradesh, 458441, IndiaCorrespondence: Vijaya Sahu, All India Institute of Medical Science, Raipur, Chhattisgarh, 492009, India, Tel +91975267955, Email drvijayasahu77@gmail.comAbstract: One of the most recent advancements in the field of cataract surgery is optical biometry. With the advent of optical biometry ocular measurements are now simpler, quicker, and more precise. The devices have made intraocular lens (IOL) power calculations easier in difficult situations too, such as in cases with extremes of axial lengths, silicone filled eyes, cataract surgery in post-keratoplasty eyes, post Laser-Assisted in Situ Keratomileusis (LASIK) eyes, etc. The gold standard for IOL power calculation in the present day is by the use of optical biometry devices. The anatomical measurements by these devices are highly precise and because of these measurements and the incorporation of various IOL power calculation formulas the optical biometry devices give the accurate power and the post-operative visual outcome is highly satisfactory among the patients. The growing use of these devices has made cataract the most commonly performed refractive surgical procedure nowadays. In the current scenario, optical biometry has widespread acceptance in almost all countries and has many advantages over ultrasound or immersion biometry. Cataract surgeons can obtain easy and reliable measurements from these devices. Refractive surprises have also decreased considerably with their use. This article will comprehensively review the principles of the various optical biometry devices, the parameters used in each of the devices, the advantages and disadvantages, and add more like what all this article will add.Keywords: optical biometry, IOL master 500, IOL master 700, lenstar LS 900, OA 2000, aladdin

In this work, the effect of bi-substitution of Zn and Ce at Cu and Ti sites on microstructure and dielectric properties of CaCu3Ti4O12 ceramics was investigated. The doped CaCu3-xZnxTi4-xCexO12 (CCZTC-x) powders (where x = 0.1, 0.2 and 0.3) were successfully synthesized via semi-wet route and the corresponding ceramics were obtained by sintering at 950 °C for 14 h in air. The presence of major cubic CaCu3Ti4O12 phase along with minor secondary CuO phase was observed by X-ray diffraction analysis. Scanning electron microscopy analyses confirmed microstructure consisting of cubic-shaped grains and grain sizes of 0.76, 0.87 and 0.98 μm, for the ceramics with x = 0.1, 0.2 and 0.3, respectively. The high value of relative dielectric constant of 1500 at 100Hz was found for the sample with x = 0.3, which may be regarded as having semiconducting grains surrounded by insulating grain boundaries. In addition, conductivity of the sintered samples decreases with doping concentrations and the activation energies of the samples with x = 0.1, 0.2 and 0.3 are 0.93, 0.76 and 0.74 eV, respectively.

A non-local yet gauge-invariantly massive 2-form model is considered that leads to local and unitary dynamics upon proper gauge-fixing. Since canonical momenta cannot be defined owing to the non-locality, consistent quantization of this system warrants particular care. We construct the Dirac brackets and covariant commutators for this model, followed by its path integral quantization, leading to consistent results. These treatments underline the most efficient way to extract the physical modes and the subsequent spectrum is free from infrared ambiguity. Physically the massive 2-form represents a spin-1 excitation, with potential application to string theory and cosmology, that can mediate a screened interaction when topologically coupled to fermions.

Introduction: Geriatric dentistry plays a pivotal role in addressing the oral health needs of the elderly population, who are prone to various age-related disorders affecting the oral mucosa. This study aims to investigate the prevalence of oral mucosal lesions among geriatric patients in India, considering factors, such as age, gender, and systemic diseases. Methodology: A hospital-based retrospective study was conducted, analyzing medical and clinical examination records of 354 geriatric patients attending a dental college/hospital between 2022 and 2023. Data on demographics, systemic diseases, oral habits, and denture usage were collected, and oral mucosal lesions were classified according to the World Health Organization (WHO) criteria. Results: Among the 354 subjects examined, oral mucosal lesions were observed in 54.66% of cases. Leukoplakia (19.49%) and lichen planus (17.80%) were the most prevalent lesions, followed by malignancy (12.99%) and denture stomatitis (9.04%). The prevalence varied across age-groups, with higher rates observed in individuals aged 60–70 years. Conclusion: The study highlights the significant burden of oral mucosal lesions among geriatric patients in India, underscoring the need for targeted preventive strategies and comprehensive oral healthcare interventions tailored to the specific needs of elderly individuals.

Background: Neonatal nutrition plays a crucial role in the growth and development of infants, particularly in the neonatal intensive care unit (NICU) where specialized care is essential. This study aims to explore current practices, challenges, and innovations in the nutrition and feeding of neonates, focusing on the utilization of human milk, fortifiers, and formula. Materials and Methods: A retrospective clinical study was conducted at a tertiary care NICU over a period of two years. Data were collected from medical records of neonates admitted to the unit. Information regarding feeding practices, types of milk (human milk, fortified human milk, or formula), fortification protocols, and associated clinical outcomes were analyzed. Results: A total of 150 neonates were included in the study. The majority (85%) received some form of human milk during their NICU stay, with 60% exclusively receiving human milk. Among those receiving human milk, 40% required fortification with a human milk fortifier due to inadequate growth parameters. Formula supplementation was necessary in 25% of cases due to maternal lactation insufficiency or medical contraindications to human milk. The mean duration of parenteral nutrition was 10 days, with a median time to full enteral feeds of 14 days. Infants receiving exclusively human milk demonstrated a lower incidence of necrotizing enterocolitis (NEC) compared to those receiving formula (5% vs. 12%, P < 0.05). Conclusion: Human milk remains the preferred source of nutrition for neonates in the NICU setting, associated with lower rates of NEC and improved clinical outcomes. However, fortification with human milk fortifiers or supplementation with formula is often necessary to meet the nutritional requirements of preterm infants. Further research is needed to optimize fortification protocols and improve long-term outcomes in this vulnerable population.

This article aims to study double-diffusive magneto-convective flow of electrically conducting and Newtonian fluid in the presence of throughflow and concentration modulation. Here, two infinite horizontal plates have been considered with heated from below and cooled and salted from above. The flow is also influenced by the induced magnetic field for which a constant magnetic field is applied in the perpendicular direction to the plates and vertically upward direction. A weakly nonlinear analysis is used to obtain the expression of heat and mass transport rate using Ginzburg–Landau equation. The influence of various physical parameters on Nusselt and Sherwood numbers is presented by graphs. From the numerical outcome, it is found that Péclet, Chandrasekhar, and magnetic Prandtl numbers enhance the mass and heat transport rate, while Lewis number increases only the rate of mass transport. The major result of this study is that the onset of convection postpones in the presence of throughflow and magnetic field.

Study region: Sharavati River, Karnataka, India. Study focus: A small mountainous river system, Sharavati, was selected to study the impact of river damming on the hydrological cycle. Sharavati river flow is regulated by two dams, Linganamakki and Gersoppa. Despite the Western Ghats' global significance in controlling local and regional climates, the effects of damming on its hydrological cycles have received limited attention. A stable water isotopic approach was employed in the study. New hydrological insights for the region: The line-conditioned excess (lc-excess) was primarily negative across all seasons. Notably, the pre-monsoon season exhibited comparatively higher evaporation with high negative lc-excess, while the postmonsoon lc-excess values approached zero, indicating minimal evaporation. The sampling points from the dams exhibited very high evaporation signals, the evaporative loss during the pre-monsoon season from the Linganamakki reservoir was estimated as 10 %, and from the Gersoppa dam was 6 %. Consequently, groundwater sampled near the dams, plotted along the local evaporation line indicating recharge from the evaporated reservoir water. Damming has affected the hydrological cycle of the heavily regulated Sharavati River, transforming the entire catchment into a connected, narrow lake-like structure, especially during the pre-monsoon season. Since the Western Ghat river systems are regulated by many large and small dams, it is pertinent to study the impact of damming on the hydrological cycles of the entire system.

Microplastic (MP) contamination in freshwater systems is a prevalent and persistent environmental issue, yet their occurrence and distribution remain poorly constrained. The present study examines the MPs abundance in sediment and water samples and factors controlling their distribution in the Manasbal Lake, north-western (NW) Himalaya. Additionally, the study investigates the relationship between heavy metals and the distribution of MPs in sediment, as well as their potential interactions. The MPs counts in lake surface sediment and water samples varied from 840 nkg−1 to 4020 nkg−1 and 13 nL−1 to 89 nL−1, respectively. The MPs distribution in Manasbal Lake exhibited spatial heterogeneity, with the greatest abundance observed in the eastern and northeastern areas near lake inlets. Grain size and land use appear to collectively modulate the variability of MPs in Manasbal Lake sediments. Five main MPs types were identified: beads/pellets, fragments, fibres, foams, and films, with beads being the predominant type. Polypropylene, polyethylene, and polystyrene are the dominant constituents of the observed MPs, with domestic sewage suggested as the predominant source for their abundance in the lake. Furthermore, the contamination factor for heavy metals indicated a high level of lead contamination in surface sediments, while copper and cobalt showed moderate contamination near the lake inlet. The SEM-EDS analysis illustrated the presence of toxic elements such as Hg, Zn, Pb, Cr, Cd, Ni, and Cu to the surface of MPs. This study expands the baseline characterization of MPs in freshwater systems and enhances our understanding of the potential sources and factors influencing MP distribution.

AimMitochondriogenesis refers to the process of creating and maintaining mitochondria, which plays an essential role in cellular metabolism. Mitochondrial processes such as energy generation, the response to oxidative stress, and cell death are all tightly regulated by enzymes. The flavonoid molecule malvidin-3-glucoside (M3G), which may be found in a wide variety of fruits and vegetables, has been shown to improve mitochondrial activity. However, the precise enzymes that mediate M3G’s effect on mitochondriogenesis are yet unknown. MethodHere, we used in silico molecular modeling tools to look at how enzymes contribute to mitochondriogenesis after M3G administration. We used computational methods to discover candidate target enzymes known to interact with M3G and play important roles in mitochondrial physiology. Molecular docking was conducted to measure the binding affinity and stability of the M3G-enzyme complexes. The found enzymes’ structural and functional features were analyzed using bioinformatics techniques, and the predicted functional implications of their interaction with M3G were formulated. ResultOur goal in doing these studies was to understand better how M3G regulates mitochondriogenesis by the action of altering SIRT-1, AMPK, and PGC-1α via M3G. ConclusionIn sum, our findings provide light on the molecular pathways by which M3G influences mitochondriogenesis. Furthermore, experimental validation of the discovered enzymes and their interactions with M3G may aid in the development of therapeutic approaches to improve mitochondrial function and cellular health.

Samar Abdelazim Ahmed,1,2 Nagwa N Hegazy,3 Hebat Allah Ahmed Amin,4 Mariam IM Ismail,5 Yasser Fouad Alakid,6 Archana Prabu Kumar7 1Dubai Medical College for Girls, Dubai, United Arab Emirates; 2Forensic Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 3Family Medicine Department, Faculty of Medicine, Menoufia University (MU), Menoufia, Egypt; 4Pathology Department, Faculty of Medicine, Helwan University, Helwan, Egypt; 5Faculty of Medicine, Delta University, Dakahlia, Egypt; 6Forensic Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 7Medical Education Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, BahrainCorrespondence: Samar Abdelazim Ahmed, Email Prof.samar@dmcg.eduBackground: Culture is an essential component that governs all aspects of human behavior. Superstition is an irrational belief observed in almost all cultures. It is linked to one or more factors like supernatural powers, good luck, bad omen, fiction, illegitimate activity, absurd narration, folk tales, or practice without any rational basis.Methods: A cross-sectional social experiment was conducted to evaluate the effect of cultural appropriation as a tool to enhance medical knowledge acquisition and attitudinal development in medical education. The experiment was designed to target a non-medical population. Four superstition-oriented videos were developed with 20 scientific pieces of information related to forensic medicine. A data collection sheet was developed on Microsoft form with 16 questions was distributed on the participants.Results: Out of the 986 participants, 763 (77.5%) watched the whole set of videos. About 55– 95% of responders demonstrated knowledge acquisition of all the questions. There was a statistically significant difference between those who watched the videos and those who did not. When participants were asked about the most important information they remember from the videos, their answers fell into two main categories; information related to core scientific knowledge (80% of participants) and information not related to the core knowledge (16% of respondents). The top three areas for the reasons why people wanted to watch the videos were curiosity, knowledge, and career. A change in attitudes was reported among the participants where 80% of responders demonstrated curiosity to know more about this world, 46% responders reported developing more respect for the forensic physician and 43% revealed their ignorance about this great hidden world.Conclusion: Cultural appropriation could be a needed strategy to accommodate for upscale in education. Learners might validate that learning happens through a door that adopts not only honours their culture and adapts to it.Keywords: contextualization, knowledge acquisition, medical education

Signal detection in orthogonal time frequency space modulation is one of the critical aspects for enhancing the throughput of the beyond fifth-generation framework, especially in challenging environments characterized by high mobility and multipath propagation. In this work, we proposed a hybrid detection algorithm by combining zero-forcing equalization (ZFE) and minimum square error equalization (MMSE), also known as ZFE–MMSE, with Rician and Rayleigh channels for 64 and 256 quadrature amplitude modulation. The combination of ZFE and MMSE allows for a more comprehensive approach to equalization. ZFE addresses channel-induced distortions, while MMSE tackles the impact of noise. Together, they enhance the overall performance of the equalization process, resulting in improved signal detection accuracy. The analysis and comparison of the simulation parameters with traditional detection systems include bit error rate, power spectral density (PSD), and complexity. The projected algorithms achieve a signal-to-noise ratio and a PSD gain of 2 dB and −800, respectively, outperforming the traditional detection techniques.

In this work, we propose a hybrid impulsive prey-predator-mutualist model on nonuniform time domains. We have investigated the permanence/persistence results for the proposed model using the comparison theorems of impulsive differential equations and some dynamic inequality on the nonuniform time domains. In addition, we have established certain necessary requirements for the uniform asymptotic stability of the almost periodic solution and global attractivity of the proposed model. Furthermore, we provide several numerical examples on nonuniform time domains with computer simulation to demonstrate the viability of the results of the acquired analytical work.

Abstract Modern deep learning training procedures rely on model regularization techniques such as data augmentation methods, which generate training samples that increase the diversity of data and richness of label information. A popular recent method, mixup, uses convex combinations of pairs of original samples to generate new samples. However, as we show in our experiments, mixup can produce undesirable synthetic samples, where the data is sampled off the manifold and can contain incorrect labels. We propose $$\zeta $$ ζ -mixup, a generalization of mixup with provably and demonstrably desirable properties that allows convex combinations of $${T} \ge 2$$ T ≥ 2 samples, leading to more realistic and diverse outputs that incorporate information from $${T}$$ T original samples by using a p-series interpolant. We show that, compared to mixup, $$\zeta $$ ζ -mixup better preserves the intrinsic dimensionality of the original datasets, which is a desirable property for training generalizable models. Furthermore, we show that our implementation of $$\zeta $$ ζ -mixup is faster than mixup, and extensive evaluation on controlled synthetic and 26 diverse real-world natural and medical image classification datasets shows that $$\zeta $$ ζ -mixup outperforms mixup, CutMix, and traditional data augmentation techniques. The code will be released at https://github.com/kakumarabhishek/zeta-mixup .

In this article, we present a susceptible, exposed, infected, hospitalized and recovered compartmental model for COVID-19 with vaccination strategies and mask efficiency. Initially, we established the positivity and boundedness of the solutions to ensure realistic predictions. To assess the epidemiological relevance of the system, an examination is conducted to ascertain the local stability of the endemic equilibrium and the global stability across two equilibrium points are carried out. The global stability of the system is demonstrated using Lyapunov’s direct method. The disease-free equilibrium is globally asymptotically stable when the basic reproduction number (BRN) is less than one, whereas the endemic equilibrium is globally asymptotically stable when BRN is greater than one. A sensitivity analysis is performed to identify the influential factors in the BRN. The impact of various time-dependent strategies for managing and regulating the dynamic transmission of COVID-19 is investigated. In this study, Pontryagin’s maximum principle for optimal control analysis is used to identify the most effective strategy for controlling the disease, including single, coupled, and threefold interventions. Single-control interventions reveal physical distancing as the most effective strategy, coupled measures reduce exposed populations, and implementing all controls reduces susceptibility and infections.

The focus of governments around the globe to accelerate economic growth through market-driven policies has resulted merely in increasing GDP while deterring certain groups from becoming a part of their development agenda. This turned the focus of leading international developmental communities toward the concept of inclusive growth that strives to reduce poverty and inequality by creating equitable and productive opportunities for all sections of society, including the often-excluded ones. Considering its profound and wide-ranging impacts on the destination’s economy, the tourism industry has been identified as a harbinger of inclusive growth. The conception of tourism-led inclusive growth remains contended in the academic literature. Therefore, as an attempt to contribute to the existing debate, the present study has been undertaken to explore the rapport between tourism and inclusive growth by systematically reviewing the scientific literature and the evolutionary nuances of this research field. The literature for this purpose was derived from the two most renowned databases viz. Scopus and Web of Science. The content analysis of 27 systematically selected articles performed in the present study highlighted a set of seven noteworthy research areas/themes and a variety of topics under each theme that shape the knowledge structure of the underlying research field. The overall analysis calls for further investigations in the tourism sectors of low-income nations to find significant empirical evidence that may validate the hypothesis of tourism-led inclusive growth and signals a need for evidence-based frameworks to harness inclusive growth through tourism development.

PurposeThe present study aims to identify the crucial determinants of the adoption of zero-tillage (ZT) technology in maize production in peninsular India. The study also measures the impact of ZT adoption on maize yield, income generation, and the expenses associated with different agricultural operations.MethodologyThe study used multi-stage stratified random sampling and conducted a face-to-face questionnaire survey to collect primary data from 1,189 maize farmers. Initially, the study employed probit regression analysis to identify the ZT adoption determinants. Subsequently, using the Propensity Score Matching (PSM) approach, the study measures the impact of ZT adoption over conventional tillage in terms of yield, income, and cost management. Finally, the Endogenous Switch Regression (ESR) method was implemented to mitigate unobserved heterogeneity and sample selection bias. Additionally, ESR assessed the robustness of PSM results.FindingsThe probit model identifies that variables like education, institutional credit adoption, crop insurance, visit of extension agent, landholding size, and prior experience of new technology adoption positively influence ZT adoption. The PSM and ESR approach results suggest that ZT adoption positively impacts farmers’ yield and net income while reducing cultivation costs and labor use. Results show that ZT adoption decreases the cost of land preparation, weed, pest management, and harvesting by INR 2708 acre−1, INR 167 acre−1, and INR 649 acre−1, respectively, thereby decreasing the overall cultivation cost by INR 8376 acre−1. However, seed and seed treatment costs and irrigation costs improve by INR 108 acre−1 and 176 acre−1 due to the adoption of ZT in maize cultivation. Moreover, ZT improves maize yield by 2.53 quintal acre−1 and minimises 9.56 person-days acre−1. ESR results suggest that the net return from maize cultivation is 26.1% higher for ZT adopters than conventional farmers. Additionally, ZT adopters can save 8.23 man-days acre−1, providing additional monetary benefits of INR 3259 acre−1 compared to ZT non-adopters.Practical implicationsThe study findings may support policymakers in designing suitable agricultural policies to improve technology adoption and motivate small and marginal maize farmers for sustainable production.

Abstract The spatio-temporal distribution of COVID-19 across India’s states and union territories is not uniform, and the reasons for the heterogeneous spread are unclear. Identifying the space–time trends and underlying indicators influencing COVID-19 epidemiology at micro-administrative units (districts) will help guide public health strategies. The district-wise daily COVID-19 data of cases and deaths from February 2020 to August 2021 (COVID-19 waves-I and II) for the entire country were downloaded and curated from public databases. The COVID-19 data normalized with the projected population (2020) and used for space–time trend analysis shows the states/districts in southern India are the worst hit. Coastal districts and districts adjoining large urban regions of Mumbai, Chennai, Bengaluru, Goa, and New Delhi experienced > 50,001 cases per million population. Negative binomial regression analysis with 21 independent variables (identified through multicollinearity analysis, with VIF

The adaptive control method is a technique that measures the dynamic characteristics of the plant automatically and continuously to make a comparison with its required output. It utilizes the difference between plant output and reference output to compute adaptable system parameters to maintain optimal performance regardless of the system variations. The behavior of the adaptation rule is significantly affected by the adaptation gain value. This paper describes the design of MIT (Massachusetts Institute of Technology) and Lyapunov rule-based modified Model Reference Adaptative Controller (MRAC) to stabilize a non-interacting and interacting two-tank process system. Investigation of variation in adaptation gain has also been done. Initially, a traditional MIT and Lyapunov rule-based MRAC is designed to stabilize the non-interacting and interacting tow-tank coupled system and it is found that both the systems are stable only for a few values of adaptation gain. To overcome this problem the modified MRAC is planned to stabilize and improve the response of the system. The modified MRAC scheme is just the PD (Proportional Derivative) controller superimposed on the MRAC control method. Now with the modified MRAC, the systems have been stabilized and their response has been improved for the wide range of adaptation gains. The comparative analysis of traditional and modified MRAC has also been presented. The performance analysis in terms of rise time, settling time, and peak overshoot has been carried out by comparing the results obtained for all the mentioned rules with the variations in the adaptation gain, on the MATLAB/Simulink platform. The obtained results present encouraging outcomes.

Abstract Pneumonia is a widespread and acute respiratory infection that impacts people of all ages. Early detection and treatment of pneumonia are essential for avoiding complications and enhancing clinical results. We can reduce mortality, improve healthcare efficiency, and contribute to the global battle against a disease that has plagued humanity for centuries by devising and deploying effective detection methods. Detecting pneumonia is not only a medical necessity but also a humanitarian imperative and a technological frontier. Chest X-rays are a frequently used imaging modality for diagnosing pneumonia. This paper examines in detail a cutting-edge method for detecting pneumonia implemented on the Vision Transformer (ViT) architecture on a public dataset of chest X-rays available on Kaggle. To acquire global context and spatial relationships from chest X-ray images, the proposed framework deploys the ViT model, which integrates self-attention mechanisms and transformer architecture. According to our experimentation with the proposed Vision Transformer-based framework, it achieves a higher accuracy of 97.61%, sensitivity of 95%, and specificity of 98% in detecting pneumonia from chest X-rays. The ViT model is preferable for capturing global context, comprehending spatial relationships, and processing images that have different resolutions. The framework establishes its efficacy as a robust pneumonia detection solution by surpassing convolutional neural network (CNN) based architectures.

Investors today are more inclined towards a financial market that increases their knowledge and excess involvement. It is often observed that they are extensively emotionally involved, that impact financial investors’ investment decisions. It is observed that investors always seek guidance from an expert to invest in more appropriate products and services. This guidance and support lead to reaching the ultimate satisfaction of the participants.

Background: A surgical site infection (SSI) is any infection occurring after a medical intervention. It is the most common nosocomial infection in low- and middle-income countries. It has raised both mortality and morbidity. Resistance to antibiotics due to irrational use has further added to the severity of the problem. Aims and Objectives: The current study was designed with the aim of determining the incidence of SSIs among patients operated on a tertiary care hospital, along with their antibiogram. Materials and Methods: An observational study with a cross-sectional design was conducted on 150 patients with suspected SSI were included in this study over a period of 1 year, from August 2021 to July 2022. An adult patient with pus, serous, or seropurulent discharge from the surgical wound was included in the study. Information was obtained using a pre-designed and pre-tested schedule. Identification of the colony was done by gram staining and inoculation on 5% sheep blood agar and Mac Conkey agar plates. Antimicrobial sensitivity testing was done. The data was analyzed using Microsoft Excel. Results: A total of 152 patients were included in the study. The incidence of SSI was found to be 38.2%. The mean age of the participants was 47.7 ± 21.6 years. The maximum incidence of SSI was noted in the 5th decade of life. Among the 58 patients’ samples, 65 aerobic bacterial colonies were isolated. Out of which Staphylococcus aureus and Escherichia coli were the commonest organisms. On performing an antibiogram, a higher degree of resistance was observed among Gram-negative organisms. Conclusion: SSI adds to the mortality as well as the morbidity of the patients. Not only this, but it also adds to the expenses. A more stringent surveillance system and reinforcement of the guidelines was the need of the hour to overcome this problem of hospital-acquired infections.

Payal Deepak,1 Praveen Kumar,2,3 Prashant Pandey,1 Dilip Kumar Arya,1 Shweta Jaiswal,1 Anand Kumar,1 Archana Bharti Sonkar,1 Daoud Ali,4 Saud Alarifi,4 Mohankumar Ramar,5 P S Rajinikanth1 1Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Lucknow, Uttar Pradesh, India; 2Department of Pharmacy, Indira Gandhi National Tribal University, Amarkantak, Madhya Pradesh, India; 3S.D College of Pharmacy and Vocational Studies, Muzaffarnagar, Uttar Pradesh, India; 4Department of Zoology, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia; 5Department of Pharmacology and Toxicology, School of Pharmacy, University of Connecticut, Storrs, CT, 02903, USACorrespondence: P S Rajinikanth, Department of Pharmaceutical Sciences Babasaheb Bhimrao Ambedkar University, Lucknow, Uttar Pradesh, 226025, India, Email psrajinikanth222@gmail.comBackground: Antitumor research aims to efficiently target hepatocarcinoma cells (HCC) for drug delivery. Nanostructured lipid carriers (NLCs) are promising for active tumour targeting. Cell-penetrating peptides are feasible ligands for targeted cancer treatment.Methods: In this study, we optimized gefitinib-loaded NLCs (GF-NLC) for HCC treatment. The NLCs contained cholesterol, oleic acid, Pluronic F-68, and Phospholipon 90G. The NLC surface was functionalized to enhance targeting with the cRGDfK-pentapeptide, which binds to the αvβ 3 integrin receptor overexpressed on hepatocarcinoma cells.Results: GF-NLC formulation was thoroughly characterized for various parameters using differential scanning calorimetry and X-ray diffraction analysis. In-vitro and in-vivo studies on the HepG2 cell line showed cRGDfK@GF-NLC’s superiority over GF-NLC and free gefitinib. cRGDfK@GF-NLC exhibited significantly higher cytotoxicity, growth inhibition, and cellular internalization. Biodistribution studies demonstrated enhanced tumour site accumulation without organ toxicity. The findings highlight cRGDfK@GF-NLC as a highly efficient carrier for targeted drug delivery, surpassing non-functionalized NLCs. These functionalized NLCs offer promising prospects for improving hepatocarcinoma therapy outcomes by specifically targeting HCC cells.Conclusion: Based on these findings, cRGDfK@GF-NLC holds immense potential as a highly efficient carrier for targeted drug delivery of anticancer agents, surpassing the capabilities of non-functionalized NLCs. This research opens up new avenues for effective treatment strategies in hepatocarcinoma. Keywords: nanostructured lipid carrier, αvβ 3 integrin receptor, cRGDfK-pentapeptide, hepatocellular carcinoma, tumour targeting

Healthcare 4.0 is considered the most promising technology for gathering data from humans and strongly couples with a communication system for precise clinical and diagnosis performance. Though sensor-driven devices have largely made our everyday lives easier, these technologies have been suffering from various security challenges. Because of data breaches and privacy issues, this heightens the demand for a comprehensive healthcare solution. Since most healthcare data are sensitive and valuable and transferred mostly via the Internet, the safety and confidentiality of patient data remain an important concern. To face the security challenges in Healthcare 4.0, Web 3.0 and blockchain technology have been increasingly deployed to resolve the security breaches due to their immutability and decentralized properties. In this research article, a Web 3.0 ensemble hybrid chaotic blockchain framework is proposed for effective and secure authentication in the Healthcare 4.0 industry. The proposed framework uses the Infura Web API, Web 3.0, hybrid chaotic keys, Ganache interfaces, and MongoDB. To allow for more secure authentication, an ensemble of scroll and Henon maps is deployed to formulate the high dynamic hashes during the formation of genesis blocks, and all of the data are backed in the proposed model. The complete framework was tested in Ethereum blockchain using Web 3.0, in which Python 3.19 is used as the major programming tool for developing the different interfaces. Formal analysis is carried out with Burrows–Abadi–Needham Logic (BAN) to assess the cybersecurity reliability of the suggested framework, and NIST standard tests are used for a thorough review. Furthermore, the robustness of the proposed blockchain is also measured and compared with the other secured blockchain frameworks. Experimental results demonstrate that the proposed model exhibited more defensive characteristics against multiple attacks and outperformed the other models in terms of complexity and robustness. Finally, the paper gives a panoramic view of integrating Web 3.0 with the blockchain and the inevitable directions of a secured authentication framework for Healthcare 4.0.

The geometry and sharpness of the cutting tool have a substantial impact on the final product’s quality. The geometry of cutting edges is altered throughout the machining process, and wear causes the cutting edge to become dull. This causes increased surface roughness, dimensional inaccuracy, cutting forces, chatter, and vibration. The present research focuses on tool wear (Vb) under dry machining conditions during ball end milling of Ti6Al4V alloy. The experiments are conducted using the full factorial design of experiments with three parameters, viz. feed (f), depth of cut (A t), and rotational speed (S) at three levels. A total of 27 experiments are conducted with one replicate. Artificial neural network (ANN) with 3-18-2-1 architecture is used for the study of the tool wear monitoring (TWM) system. Results revealed that the TWM model is highly adequate, with R 2 = 99.89% and R 2adj = 99.65%. The percentage contribution of A t is the highest, amounting to 80.6%, followed by feed of 12.46%. The rotational speed has the least contribution to tool wear, amounting to 1.5%. From ANN modeling, R 2 value testing is found to be 0.9974, which is close to unity and reveals that the trained model excellently fitted the testing data. The model accuracy is also found to be 96.46%.

Due to its low density, magnesium is recognized as a lighter metal and it is favorable for frequent use in industries. It is used in aerospace, biomedical, automotive, and other industrial applications. Magnesium is a promising element that is vital for reducing emissions, improving efficiency, protecting the environment, and enhancing the machine economy. This study analyzes the influence of various cutting environments and parameters on the turning operation of magnesium base alloy (AZ91D). Aluminum 9% and Zinc 1% is the main constituent of AZ91D. The machining process was accomplished using dry, minimum quantity lubrication (MQL), and nano minimum quantity lubrication (NMQL) environments based on their influence on surface roughness (SR) and temperature. Under certain circumstances, it was observed that SR decreases with the increase in the cutting velocity (V c), feed rate, and depth of cut. During cutting of AZ91D in dry conditions, it is preferred to use a moderate speed. Higher temperature was recorded during dry conditions which can significantly reduce the life span of the tool. MQL and NMQL have reduced the cutting temperature by a margin of 25–40% compared to dry machining, thus improving tool life. NMQL has shown decent cooling results compared to other cooling systems.

The need for sheet metal forming using highly resistant materials such as titanium alloys and stainless steel has increased recently. These materials possess elevated mean flow stress values, which make them difficult to draw at room temperature. To achieve a homogeneous distribution of strain in the stretched component, reduce the load required for plastic deformation, and greatly improve material formability, hot forming is helpful. The goal of the current study is to conduct stretch-forming experiments to investigate the forming characteristics of Austenitic material Stainless Steel (ASS) 304 at Hot working temperatures. Stretch forming experiments have been conducted on the Servo electrical sheet press test machine at 650 and 800°C. The formability has been estimated by constructing a Fracture forming diagram (FFLD), limiting the height of the dome (LDH) and the distribution of the strain of stretched cups. It has been discovered that the limit of forming bounds rises with the temperature reaching 800°C, while the DSA effect causes the necking region – the area between the safe and fracture limits ‒ to decrease with additional temperature rise from 800 to 900°C. Within the experimental limitations, it has been considered that the Hot forming of ASS 304 at 650°C gives the highest strain forming limits with a uniform strain distribution in the stretched cups. From the Formability limit diagram, dome height, and strain distribution, it can be observed that ASS 304 has good limiting strain up to 800°C with lower load application.

One of the most common characteristics of metallic alloys is work hardening, which is most beneficial as it is the primary reason for the alloys’ tenacity to withstand loading even in the presence of internal flaws or geometrical errors. Thus, the work hardening coefficient gives the maximum amount of homogeneous plastic deformation in tensile straining. Thus, complex-forming operations are facilitated by a high coefficient without experiencing premature failure. Naturally, work hardening has a significant impact on the mechanical energy required to shape a material by plastic deformation, such as rolling, forming, etc. The quantity of energy that the material stores during plastic deformation is also managed by work hardening. As a result, it significantly influences how the metal behaves when it is subsequently softened during annealing. Finally, the hardening capacity and durability of the work hardened state are significant practical challenges because many high-volume stretch formed components are directly used. Typically, the current study begins, at homologous temperatures above 0.4 times melting point, with a description of work hardening at 700, 800, and 900°C temperatures in three different orientations with respect to rolling direction R 0, R 45, and R 90 and 10−1−10−3 s−1 strain rates, where thermally triggered processes exhibit a prominent role in work hardening. Three stages of behavior were identified by analyzing the tensile work hardening of ASS 304 steel. Dynamic strain aging is the cause of the anomalous fluctuation in the work hardening rate that is seen in hot working temperatures. X-ray diffraction examination is conducted to introspect any phase changes occurring in hot working regions improving plasticity of ASS 304.

Background: Dermoscopy is a non-invasive method of evaluating disorders of the skin. Dermoscopy of hair and scalp disorders termed trichoscopy is useful in assessing scalp disorders with alopecia. Aim and Objectives: The aim of the study was to evaluate trichoscopic features of common scalp disorders with alopecia. The primary objective was to identify distinctive features of these disorders while the secondary objective was to formulate a simplified algorithm to arrive at a diagnosis. Material and Methods: A descriptive, cross sectional study of common scalp disorders with alopecia was conducted over a period of 2 years at a tertiary care centre. Two hundred cases were enrolled after obtaining approval of ethics committee and informed consent of patients. A detailed history was taken and general physical and dermatological examination carried out. Trichoscopic evaluation was carried out using Heine Delta 20T dermatoscope. Results: Common scalp disorders with alopecia included male pattern androgenetic alopecia (20.5%), alopecia areata (19.5%), telogen effluvium (12.5%) and female pattern hair loss (10.5%) and their trichoscopic features were tabulated. On the basis of trichoscopic features, an algorithm for rapid diagnosis was formulated. Conclusion: Common scalp disorders with alopecia have characteristic trichoscopic signs. A simplified algorithm formulated from the study may help in rapid diagnosis.